Information Request Form

Requests are processed within 3 – 5 business days

I am a….*

Current Student
Former Student

REOC Student ID or Social Security #*

Full Name*

Maiden/Other Name(s)

Telephone #*

Email*

Year attended*

Program*

I am requesting a copy of:*

Detailed Attendance Report (Current students only)
Immunization/Health Records
Test Scores (Specify test type below)
Transcript
Verification of Enrollment
Other (please list below)

Test Type

Other Request Description

Specify where information should be mailed (Official Transcripts are not given directly to students):*

By signing below, I authorize the College at Brockport Rochester Educational Opportunity Center to release the information requested above to the parties indicated. (please print full name)*

Phone

This field is for validation purposes and should be left unchanged.

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